Individual
CAROL A LOUCKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1629 W 1170 N, PROVO, UT 84604-2923
(801) 472-6111
Mailing address
1629 W 1170 N, PROVO, UT 84604-2923
(801) 472-6111
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
202205-4405
UT
Other
Enumeration date
11/29/2011
Last updated
11/29/2011
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